Anesthesia Provider Practice Concerns at the W.G. (Bill) Hefner VA Medical Center in Salisbury, North Carolina

The VA Office of Inspector General (OIG) initiated an inspection in response to anesthesia provider practice concerns, including unsafe practices such as technique and choice of medications, alleged to have affected patient care at the W.G. (Bill) Hefner VA Medical Center in Salisbury, North Carolina. The OIG did not substantiate unsafe practices within the context of nine patient electronic health records reviewed. The OIG did not identify issues related to the quality of anesthesia care. However, initial hiring process deficiencies were noted related to the provider’s reporting, and the facility’s verification, of previous employment. The provider did not document a prior discharge from a position with a locum tenens contracting company, and facility credentialing and privileging staff did not complete timely verifications. The OIG also found gaps in the provider’s personnel file—proficiency reports for fiscal years 2013 and 2014 were missing, and when asked, facility staff were unable to locate them. The OIG noted that current Veterans Health Administration (VHA) policy does not specifically require physician applicants to list locum tenens contracting companies as part of their employment history, which could result in omissions and place facilities at risk for selecting unsuitable providers. The OIG determined that facility staff did not consistently follow VHA policy to report patient safety events and quality of care concerns, which affected facility leaders’ ability to respond and take action. The OIG made five recommendations including one to the Under Secretary for Health to review VHA’s credentialing policy related to applicants listing prior positions with contracting companies. The other four recommendations to the Facility Director related to ensuring timely applicant credentialing and privileging, completing and maintaining annual proficiency reports, providing performance and competency information to the Professional Standards Board for consideration during probationary and reprivileging reviews, and training facility staff on patient safety reporting.